Cognitive Impairment and Problem Behaviors as Risk Factors for Institutionalization

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Abstract
Data from the 1982 and 1984 National Long-Term Care Surveys are used to develop a predictive model for nursing home institutionalization that includes cognitive functioning and problem behaviors in addition to more commonly studied indicators such as disability. As expected, cognitive impairment is a risk factor for institutionalization, controlling for other characteristics such as age, living arrangement, and use of paid inhome care. Four problem behaviors were investigated, but only one, Wanders/Gets Lost, contributed to the model. Among cognitively impaired persons, those who wander/get lost had a twofold risk of institutionalization. The findings suggest the need to differentiate among difficult or problem behaviors and to further investigate those that arouse concerns about safety and require extensive supervision as risk factors for institutionalization.